This matter relates to the need for the Minister for Social Protection to outline the reasons for the lengthy delays being experienced in the processing of domiciliary care allowance and to explain why the families of Jack & Jill Children's Foundation babies and others are required to complete renewal forms in light of the fact that their children's medical conditions will not improve and might be terminal.
Adjournment Matters
Social Welfare Benefits
I have been asked to deliver the reply in respect of this matter. I do not claim detailed knowledge of the brief to which it relates but I will certainly read into the record the information supplied to me. If the Senator so desires, I can pursue this matter further on her behalf with the Minister.
Domiciliary care allowance is currently paid to over 24,000 parents-guardians in respect of 26,000 children. The approximate cost in this regard in 2011 was €100 million and the accompanying respite care grant cost a further €45 million. In addition, the Department makes an extensive range of payments to support families with children. In 2011, some €2.08 billion was paid out in child benefit in respect of 1.13 million children. Qualified child increases were also paid to people on social welfare payments in respect of some 495,000 children — 369,000 at the full rate and 126,000 at the half rate.
Domiciliary care allowance can be paid in respect of children under 16 years of age who have disabilities so severe that it is necessary for them to receive care and attention and-or supervision substantially in excess of that required by other children of the same age. This care and attention must be given by another person — effectively on a full-time basis — in order that the child can deal with the activities of daily living. The child must be likely to require this level of care and attention for at least 12 months.
Eligibility for the domiciliary care allowance is not based primarily on the medical or psychological condition but on the resulting lack of function of body or mind which necessitates the degree of extra care and attention required. Each application is assessed on an individual basis, taking account of the evidence submitted. No specific condition or disability rules a child in or out of qualifying for the allowance. There are no undue delays in the processing of claims at present. The Department aims to process domiciliary care allowance claims within seven weeks. At present, however, it can take up to eight weeks to process claims as a result of the volume of work in the medical assessment area.
An expert medical group was established in advance of the transfer of the scheme from the HSE to the Department of Social Protection in 2009. This group recommended that the most appropriate way for the Department to conduct assessments in respect of medical eligibility would be by way of desk assessment of the evidence submitted by the claimant, as provided by themselves and the medical staff who regularly see the child. It was considered that it would not be necessary for a child to be physically examined by the Department's medical assessors because the diagnosis of his or her condition by his or her GP is accepted. What is being assessed is the level of additional care and attention that the child requires as a result of that condition-disability and whether this is substantially in excess of that required by a child of the same age without the condition.
A review policy is an integral part of all social welfare schemes and is necessary to ensure that payments continue to be made only to those customers who meet the qualifying conditions. Domiciliary care allowance cases are routinely reviewed to ensure that all the conditions for receipt of the payment continue to be met. Cases are reviewed on the basis of either a scheduled review on the recommendation of the medical assessor when the claim is initially processed or on information received regarding a change of circumstances which potentially affects the continued entitlement in respect of a case already in payment. Scheduled reviews, on the recommendation of the medical assessor, are based on the prognosis of a child's disability and how his or her care needs may change over time. In circumstances where a child has a lifelong disability which is unlikely to improve by any significant degree, a "do not review again" status may be used by the medical assessor. Customers who are reviewed are asked to provide relevant up-to-date medical evidence and details of the additional care needs of their child. This information is assessed by a medical adviser and a decision is made, based on the medical opinion the latter provides. Where payment is stopped as a result of a review, the customer is invited to submit any further information they may wish to have considered and that information is further examined and/or they may appeal the decision directly to the social welfare appeals office.
The effective and efficient operation of the scheme is monitored regularly and any improvements in respect of the delivery of service that are identified are implemented. I assure the Senator that the Department is committed to ensuring that those children who meet the conditions for the scheme will continue to receive the payment.
I thank the Minister for the reply. I am very familiar with the individual families that have highlighted this problem and I wish it was the case that in circumstances where a child has a lifelong disability which is unlikely to improve, a "do not review again" status is conferred. The children of the families to which I refer are very young and they have brain damage. They cannot swallow, the probably cannot hear and they experience epileptic fits every hour. These children will never throw a ball, make marmalade or visit a day centre. They are profoundly ill and they will probably not live very long lives. Most of them will die while they are young and they have no hope of ever getting well. Regardless of how much money their parents have, there is no miracle cure for these children. All I know for sure is that the families of these babies and children are having to reapply for the domiciliary care allowance, DCA. From speaking to them directly they have been affected by delays of up to eight months in their application for the DCA and, furthermore, for the granting of carer's allowance and medical cards. It will shock the Minister to hear that payments are stopped while the review is being carried out by the Department. If one's child is sick and one has to reapply for the DCA and it takes five or six months then one will not get any payments during that period. I will stop now because as the Minister can see I am on my soapbox. I ask him to pass on the details to the Minister for Social Protection, Deputy Joan Burton. Perhaps her officials are not properly briefed.
I will take the message back to the Minister. It is clear from the reply that there is a mechanism that can essentially put a stamp on a file which says that it should not be reviewed again if it is clear that a child does not have an opportunity to recover. Such a child and his or her parents or guardians have enough to do to look after each other and try to accommodate the challenges with which they may have to deal without having to go through a long process of review and assessment. It is the Minister's intention to ensure that such cases do not have to go through unnecessary review mechanisms that are clogging up the system, take a long time and stress out everyone. I will pass the message on the Minister.
That is much appreciated.
The Seanad adjourned at 2.15 p.m. until 12.30 p.m. on Wednesday, 9 May 2012.